早期胃癌診断の実際―微小胃癌・小胃癌：X線所見

Radiological Diagnosis Differentiating Minute and Small Gastric Cancer from Benign Lesions

要旨　陥凹型微小胃癌および小胃癌と形態が類似するような病変を呈示し，鑑別点を検討した．微小癌および小胃癌と良性びらんの鑑別点は陥凹の形状，輪郭の性状，辺縁隆起の性状などが挙げられる．癌の組織型から分化型と未分化型に分けてみると，分化型では辺縁の棘状ニッシェや辺縁隆起が特徴的である．未分化型では明瞭な陥凹を有するものについての診断は容易であるが，胃小区構造が残存するようなものでは，胃小区間溝の不整や胃小区の形状や大きさの不揃いが診断につながることがある．微小癌の診断は難しいが，造影剤がよく付着して胃小区が鮮明に描出された二重造影像を高解像度の装置で撮影し，注意深く読影することによりX線の発見能や質的診断能はかなり向上すると思われる．

　We discussed the differential diagnosis of the depressed type of minute and small gastric cancers from benign gastric lesions through the presentation of several cases.

　The significant radiological findings of depressed type of minute and small gastric cancer were the irregularity of the barium fleck in shape and margin and the granularity of the surrounding lucency. In the differentiated-type cancer fine spiculae around the margin of the fleck were characteristic. It was difficult to diagnose shallow Ⅱc undifferentiated-type cancer if the pattern of the gastric area was still present in it. However irregular grooves and uneven gastric area were considered to be significant in such cases. In order to diagnose minute and small gastric cancer radiologically, we should use a high-quality x-ray machine, and take double contrast images clearly visualizing the gastric area and should read the films carefully.